Guidance for Providing Care Coordination and Management to Medicaid Members Enrolled in MLTC Plans and Health Homes

  • Guidance is also available in Portable Document Format (PDF, 41KB)

The role of Managed Long Term Care (MLTC) Plans, both Partial Capitation (MLTCP) and Medicaid Advantage Plus (MAP), is to provide coordination of long term care services and supports for eligible consumers who need more than 120 days of community based long term care services.  Health Home care management is a State Plan service that is required to be offered to all consumers that meet Health Home eligibility requirements.  Eligible consumers enrolled in MLTCP and MAP Plans may also be enrolled in a Health Home.

Health Home care management services are carved out of both the MLTCP and MAP benefit package, thus both the MLTC Plan and the Health Home may bill for their respective services. However, the respective roles of the MLTCP and MAP Plan and the Health Home must be formalized by entering into a Statewide Administrative Health Home Services Agreement (ASA) using the updated template that has been developed by the Department. Reference to the updated ASA has been included in the MLTCP and MAP contract amendment.

The template ASA allocates a primary role for the coordination of long term care services to the MLTCP Plan and a primary role for the coordination of behavioral health care and other services and supports that are outside of the MLTC benefit package to the Health Home.  MLTCP Plans are responsible for coordination with the Health Home but are not responsible for Health Home management or performance or any services outside the scope of the MLTC Plan benefit package.  Since behavioral health services were carved into the MAP benefit package on January 1, 2023, the MAP plan and the Health Home must work collaboratively to ensure a single comprehensive plan of care is created for the enrollee and Health Home participant. While the template ASA provided by the Department may not be altered, a description of the in-plan and out-of-plan services and the respective responsibilities of the MLTCP and/or MAP Plan and the Health Home should be included as Appendix A or Appendix B respectively  to the ASAMLTCP and MAP Plans and Health Homes can  document the collaborative approach to care coordination in the client's care plan record using the  client level Care Planning and Coordination form.  

It will be the joint responsibility of both parties to determine which care manager will serve as the lead care manager for each consumer.  This decision will be based on the primary needs of the client and must be documented on the Care Planning and Coordination form. MLTCP and MAP Plans and Health Homes are encouraged to identify liaisons to participate in periodic meetings that will include MLTCP and MAP Plan care coordination and Health Home care management staff.  The goals of these meetings should be to:

  • Insure a team approach to care coordination
  • Avoid duplication of care
  • Improve positive outcomes for the consumer
  • Discuss quality improvement initiatives

Defining the roles and responsibilities of the MLTCP and MAP Plan and the Health Home via the ASA and associated Appendix A or Appendix B, using the client level Care Planning and Coordination form, and communicating regularly will ensure that MLTCP and MAP Plan care coordination and Health Home care management services are not duplicated.